As suicide rate rises, doctor says: 'People don't have to die.'

In taking their own lives last week, Kate Spade and Anthony Bourdain joined celebrities like Robin Williams, Chris Cornell, Marilyn Monroe and Kurt Cobain who have died by suicide.

They are the latest examples of a growing problem in the U.S., a scourge that ended the lives of 45,000 people in 2016 and led the American Psychological Association to call for a public health intervention to stem the national 25% rise in suicides since 1999. The federal Centers for Disease Control and Prevention released the grim statistics last week between the deaths of Spade and Bourdain.

America mourned their suicides in a public way. Bourdain fans set up a memorial at Manhattan's Brasserie Les Halles, where he previously worked as a chef, and mounted a campaign to push Netflix to keep his show, "Parts Unkown" available to subscribers. Thousands paid tribute to both Spade and Bourdain on social media, blanketing Twitter with posts about Spade's impeccable design style and Bourdain's discerning palate.

Their deaths revealed a complex truth: Even people who seem to have it all can hurt badly enough to decide life is no longer worth living.

"They really highlight the fact that suicide affects everyone, rich and poor, famous, not famous, young old," said Dr. Cathrine Frank, Henry Ford Health System’s chair of the Department of Psychiatry and Behavioral Health Services. "It affects a wide range of people. It’s a major public health problem.

"It’s really no different than cancer or other illnesses that we know affect a wide range of people."

In Michigan, the growth in suicide deaths is more rapid than the national average. The CDC reports suicide deaths increased nearly 33% in Michigan since 1999 to 13.3 deaths per 1,000 people in 2016. It is the 10th leading cause of death in the state, behind the flu/pneumonia and kidney disease.

The reasons why, said Frank, are myriad. But the common link in most cases is a feeling of hopelessness.

"That hopelessness can come from a number of issues," she said. "It can come from relationship loss, a breakup with a boyfriend, the loss of a child, separation in a marriage. It can build from job loss, housing problems, social problems.There’s a number of acute stressors that can lead people to feel hopeless," she said.

Among those stressors is substance use and having a pre-existing mental health condition, such as depression, though the CDC statistics showed that 54% of those who committed suicide since 1999 had no known mental health disorder.

Substance use, said Dr. Ron Samarian, chief of psychiatry at Beaumont, Royal Oak, fuels impulses and can lead a person to act rashly in a moment of despair. Alcohol, prescription drugs and street drugs can all contribute to the problem.

"There’s a very big shame component to substance abuse, which further accelerates the spiral into depression and potential suicide," Samarian said.

"People need to know that in a worst-case scenario, just pick up the phone. Just call. Just talk to someone. Fortunately there are suicide hotlines available throughout the country (800-273-8255), throughout the state and it’s a good safe place to go. They’re anonymous and they’re there to help somebody at least take the first step to get through a very, very difficult time.

"I think it's important for people to know that their distorted sense of permanent hopelessness is transient, that if they just hang on long enough, the clouds will pass. The scary part for a suicide victim is whatever trap or imprisonment they perceive themselves in will never go away. And ... that’s rarely the case. Most situations can be altered, perceptions can change and moods can improve. And those feelings, yeah, they will diminish, and there are so many survivors of suicidal thinking that will attest to that."

To slow the rise in the rate of suicides, the American Psychological Association, in its call for a public health intervention, suggested better public access to mental health screenings, insurance coverage for the prevention and treatment of mental health disorders, more evidence-based treatments and crisis services for people at risk for suicide, and a commitment to break down the stigma society places on people with mental illnesses.

There appears to be at least a little political support for the call to action. Sunday, Sen. Chuck Schumer, D.-NY, said it's time to boost federal funding for suicide prevention programs, the Wall Street Journal reported. Those toll-free suicide prevention hotlines have seen a flood of calls in the aftermath of Bourdain and Spade's deaths. The National Suicide Prevention Lifeline reported a 25% increase in calls.

Arthur Evans Jr., PhD, CEO of the American Psychological Association said society also has to put just as much effort into educating the public about the signs and symptoms of suicide risk and work to reduce stigma as we do on treating people with mental health conditions.

"If we have lots of treatments and people don’t access them because they are ashamed or they don’t know how to get them, those treatments won’t matter," he said.

"For family members, friends, those in people’s lives, it’s important that they recognize when a family member, friend or colleague is having problems and that they help them get connected to resources," he said. "When a person has a heart attack, friends know what to do. They know how to advise a family member. When somebody says, 'I’ve been thinking about hurting myself,' a lot of times, people don’t know what to do. And we have to change that if we’re going to reduce suicide rates in this country."

Samarian said he was a fan of "Parts Unknown," and recognized something wasn't quite right about Bourdain in recent episodes.

"In his last two shows, he looked a little flat," Samarian said. "He didn’t appear to be his usual buoyant self. Hindsight is 20/20, but when you know somebody who functions at a certain level that then starts operating at something less than optimal, it’s very reasonable to start opening up a conversation out of concern and love and see where that leads you.

"I feel like I knew him personally. It’s a very sad situation."

Helping people recognize those changes in a person that could be clues to worsening depression or suicide risk — changes such as talking about suicide, expressing feelings of hopelessness, personality changes, depression or giving away possessions — could be enough to save a life, he said.

"Just open it up with asking, 'How are you feeling?' " Samarian said. "You might get a variety of answers. ... A typical answer is, 'I’m fine.' But you can push it a little farther if you suspect the person isn’t fine, and politely push the envelope a little more and say, 'I noticed you haven't been appearing that you’re feeling as well, and I have concerns. Please feel free to share with me, or if you’re not comfortable with me, share with someone else.'

Refer friends who are having a hard time coping to a suicide hotline, a medical professional, or — in dire situations where there's a high risk of suicide — call 911 or take him or her to the emergency room.

"Metal health disorders, situational stress, it is all treatable," Frank said. "There is help for that. We want people to know that the mental disorders are treatable, that with many situational stresses, we can help people learn more effective coping strategies.